EVIDENCE-BASED SPIRITUAL CARE FOR CHAPLAINS: Desirable? Feasible? How do we get there? George Fitchett, DMin, PhD Department of Religion, Health and Human Values Rush University Medical Center, Chicago, IL george_fitchett@rush.edu -.46*** Hopelessness Religious Belief.17** ***p<.001, **p<.01. N = 271 Depression.69***
Outline: Evidence-Based Spiritual Care 1. Definitions 2. The case for and against 3. Some US chaplaincy-related research 4. Next steps Religious Belief ***p<.001, **p<.01. N = 271 -.46***.17** Hopelessness Depression.69***
How Do We Know Good Spiritual Care? Tradition We have always done it this way. Policy This is the way we are supposed to do it. Education I was taught to do it this way. Personal Experience/Trial and Error I found doing it this way usually works. I tried several ways and this this one works best. Intuition Doing it this way feels right to me. Research There is evidence this is the best way to do it. From Hundley, 1999 3
Evidence-Based Spiritual Care Evidence-based spiritual care is the use of scientific evidence on spirituality to inform the decisions and interventions in the spiritual care of persons Tom O Connor (2002). Journal of Religion and Health 4
What is Evidence-Based Practice? Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. APA Policy Statement on Evidence-Based Practice in Psychology, 2005
AGAINST Evidence-Based Spiritual Care It can t be done Stiger: God, the Spirit, presence, prayer, etc. are much too big and always will be mysteriously beyond our attempts to measure and quantify. Mowat: At times the good outcome of chaplain care causes distress and anxiety Walter: Routinization of spiritual care destroys its ethos - vulnerability It shouldn t be done Sulmasy: Once pastoral care services succumb to the need to prove they can decrease the length of stay or improve patient satisfaction all will be lost. Illich: Professionalized spiritual care robs people of the capacity to care for themselves and one another 6
FOR Evidence-Based Spiritual Care Evidence from research needs to inform our pastoral care. To remove the evidence from pastoral care can create a ministry that is ineffective or possibly even harmful (O Connor TSJ and Meakes E. 1998. The first article to use the term evidence-based pastoral care.) 7
FOR Evidence-Based Spiritual Care Is evidence-based spiritual care an oxymoron? I see it as a paradox, as ambiguity and as mystery (p. 261, O Connor, T,2002) Good stewardship of creation requires our best, evidence-based, care (Grossoehme in Fitchett & Grossoehme, 2011) 8
Can Religion and Science Co-Exist? Conflict: opposite and antagonistic, conflict Mutual independence: separate and different Dialogue: meeting on boundaries Integration 9 Ian Barbour (Nature, Human Nature and God 2002)
Chaplaincy: A Research-Informed Profession Standard 12: Research The chaplain practices evidence-based care including ongoing evaluation of new practices and when appropriate, contributes to or conducts research. (http://www.professionalchaplains.org) 10
Chaplaincy: A Research-Informed Profession Research Literacy All health care chaplains should be research literate Research Collaboration Some health care chaplains will be qualified to collaborate in research conducted by health care colleagues (co-investigators) Research Leadership Some health care chaplains will be qualified to lead research projects (principal investigators) 11
Chaplaincy: A Research-Informed Profession A research-literate chaplain has the ability to read, understand, and summarize a research study and to explain its relevance for his/her spiritual care. Religious Belief -.46***.17** ***p<.001, **p<.01. N = 271 Hopelessness Depression.69*** 12
Anton T. Boisen Explorations of the Inner World: A Study of Mental Disorder and Religious Experience (Willett, Clark & Company, 1936)
Chaplaincy-related Research in the US What chaplains do Describing & assessing spiritual needs & resources The impact of the chaplains care by itself The impact of the chaplains care in a multidisciplinary intervention
Spiritual need Percent Finding meaning in life 27% Finding hope 28% Overcoming fears 37% Talk about meaning of life 20% Talk about death and dying 20% Finding peace of mind 30% Spiritual needs not being met 18% Astrow et al, 2007 Describing Spiritual Needs (369 oncology outpatients in NYC)
Anger With God and Rehab Recovery Somatic Autonomy (ADL) 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 Admission 4 Mnth Follow-up 10.7 9.2 8.9 Anger (n=6) From: Fitchett, et al., Rehabilitation Psychology, 1999. 14.5 No anger (n=89)
Religious Struggle Screening Protocol in BRIGHTEN Participants (n=204) Is R/S important to you as you cope with your illness? YES (82%) How much strength or comfort do you get from your R/S right now? NO (18%) Has there ever been a time when R/S was important to you? All that I need (40%) Less than I need or none at all (42%) YES (9%) NO (9%) R/S Struggle Path 1 R/S Struggle Path 2 Fitchett and Risk, 2009 17
Effect of Chaplain Visit On COPD Patient Anxiety Intervention Gp (N=25) Control Gp (N=24) Mean Anxiety Score (0-63) 30 20 10 0 22.08 19.68 11.58 6.56 p=0.05 Baseline Anxiety Discharge Anxiety Source: Iler et al. (2001).
Effect of Chaplain Visit On COPD Patient LOS 14 p=.01 Length of Stay (LOS) 12 10 8 6 4 2 5.7 9.0 0 Intervention Gp (n=25) Control Gp (n=24) Source: Iler et al., 2001
Next Steps: Begin with Case Studies
Next Steps: Multi-disciplinary Studies
Next Steps: Outcomes Oriented Care Physicians 30 pediatricians (14 general peds, 16 peds oncology) Emphasis on tasks Chaplains help by: performing rituals liaison to family's faith group providing support and counseling especially in times of crisis like death Chaplains are members of the health care team Chaplains 22 chaplains (13 directors, 9 staff chaplains) Emphasis on perspectives Chaplains focus on: wholeness presence/companionship healing - helping people find meaning and peace via supportive relationships Chaplains wish they were included more often Overall positive view of chaplains Cadge et al., 2011
Next Steps: Outcomes Oriented Care Physicians Physicians emphasize chaplain contribution to key outcomes Address spiritual suffering Improve family-team communication Chaplains Chaplains emphasize process (presence) Chaplains provide a listening, supportive presence Chaplains comment on outcomes Physicians are aware of process Fitchett et al, J Palliat Med., 2011
Next Steps: Outcome Oriented Care Profile Concept of Holy Meaning Hope Community Discipline for Pastoral Care Giving Arthur Lucas, 2001
Next Steps: Best Practices in Chaplaincy http://healthcarechaplaincy.org/userimages/spiritual%20care%20 PTSD%20Handbook1.pdf
Next Steps: Evidence-based Care
Next Steps: Evidence-based Care
Next Steps: Chaplain Education and Certification Need to teach research literacy skills in CPE residency programs Create research journal clubs in chaplaincy departments Demonstrate research literacy for chaplaincy certification positive v. negative feelings Change in Chaplains' Feelings About Research 100% 75% 50% 25% 0% negative feelings 40% 60% pre workshop positive feelings Murphy and Fitchett, 2010 83% 17% post workshop
When it s over, I want to say: all my life I was a bride married to amazement. from When Death Comes by Mary Oliver